CASE 1A 40-year-old woman had suffered from recurrent painful ulcers of both ankles and the dorsa of the feet for 12 years. Mottling discoloration in a livedo pattern was also found over all four limbs at about the same time. The patient described the progression of red macules to purpuric papules to ulcers. Though some lesions had healed after many months, leaving white atrophic scars, new lesions developed successively. During active disease, the patient was not completely free of lesions for most of the year, with a slightly aggravated tendency during the summer months. Her medical and surgical histories were not significant; she denied any symptoms and signs that were suggestive of connective tissue diseases. A variety of topical agents and oral medications had been tried without significant effect. At presentation, crops of active lesions had appeared for 5 months, with acute exacerbation in the last 3 weeks. Treatment with oral dipyridamole and serapeptase was of no benefit